As a military-naive civilian, I’m generally opposed to the concept of carpet bombing. Too much potential for collateral damage. Though I suppose that’s the point — to throw everything you’ve got at the problem, unintended consequences be damned.

Again, generally speaking, I’d prefer a more targeted solution. Something focused on the problem at hand and, most importantly, guaranteed to work. But not every problem can be solved that way. In fact, many can’t. And I’m growing a bit fonder of carpet bombing as the best solution to one particularly big problem.

I’ve struggled with binge eating disorder (BED) for a very, very long time. Some years are better than others, but one thing is for certain: the older I get the worse it gets. Worse and worse and worse. Every period of binge eating so much more difficult to squelch than the last. When I spoke recently of wanting to give up, accepting that this is who I am, it was the binge eating in particular that I meant. I have fought for so long — 20 years at least. Probably closer to 25. I have tried a million different solutions. Books, diets, courses, websites, psychotherapy, psychiatric care. And I’m tired.

I told Celeste, my lovely Celeste, so at my last appointment. That I was done. That I was giving up.

She told me no. One more solution… one single thing left to try: medication.

Celeste and I have gone round and round about the idea of medication for several years. Incompatibility of the medication with a potential pregnancy has always been a concern though, and I wasn’t willing to put the brakes on that for any amount of time to give meds a shot.

So a few years later — pregnancy’s a no-go and the binge eating is at full force, so we’re doing it. I’m going to try the medication.

When I think back on all the years of wishing for a magic bullet, a quick cure, it’s remarkable to think how reluctant I’ve been to try what may very well be just that. However, in the interim, I’ve learned a whole lot about the treatment of substance use disorders (substance abuse, addiction) and, in particular, a lot about the concept of medication assisted treatment (MAT). What I’ve learned has been exceptionally pertinent to the way I think about medication for myself in the context of BED now.

MAT itself is somewhat controversial, for a number of reasons not worth discussing here… but what the group I work with has essentially settled on as a guiding principle is that MAT is somewhat of a misnomer as it implies that medication alone can solve what is a very complex problem. We prefer the idea of TAM — treatment assisted with medication. In the case of addiction, it’s using medication to beat back the cravings to such a point that the mind can get to a place capable of recovery. And what that entails, in addition to taking the medication carefully and as prescribed, is a LOT of work, a lot of different kinds of work, and a desperate hope that some bit of that work sticks. Carpet bombing.

Perhaps my situation is not so different. I don’t mean to suggest that BED is on par with or the same as addiction in the traditional sense (although arguments can be made for crossover of elements of BED with elements of substance use disorders as well as obsessive compulsive disorder), but perhaps the treatment paradigm ought to be similar. I don’t want to hang all my hopes on medication and forget about the rest of it. I feel so close to giving up, so tired of trying, if this is to be it — it needs to be it. All in.

Since Celeste wrote my prescription, I’ve spent a lot of time thinking about (and researching) what it would mean for me to be all in. Outcomes for BED treatment are variable and relatively poor — so what to choose? Medication is now on the table, but what else? What else is there that I haven’t tried? The answer, as far as I can tell, is nothing… at least on its own.

So: carpet bombing.

I’m pulling out all the stops and trying it all at once, hoping against hope that something… anything… sticks. My medication finally arrived at noon today and I took my first dose at 12:01, right on time. I’ve ordered an UpToDate-recommended cognitive behavioral therapy (CBT) workbook that I’ll use in conjunction with my routine psychotherapy appointments. And I joined a healthy lifestyles coaching program to focus on the intensive behavioral therapy (IBT) principles espoused by the US Preventive Services Task Force…

If you’re new around here… or just don’t remember clearly every word I’ve ever written (gasp!) and you’re interested in learning a little bit more about my historical battle with BED and body image, you might consider reading these:

Healthy office snacks are for healthcare establishments that practice what they preach. Not mine.

Given that we’re all a bit isolated in our own offices and, dare I say, a bit self-conscious (or maybe I’m projecting?) it tends not to be terribly obvious who ate what exactly.

Not that it really matters.

Let me rephrase that.

Not that it really matter to everyone.

Almost every time, though, someone gets worked up that maybe the snacks are disappearing and that housekeeping (gasp!) is the one eating them.

How dare they?!

Well. Because. They’re snacks. For the office. And the housekeeping folks come around the office day after day, just like all the non-housekeeping folks do. So what if they ate the snacks? If they did, quite frankly, I hope they enjoyed it. Certainly not worth the upset. Right?

Garbage Birds

I’ve got five bird feeders hanging around my backyard. At our old place, it used to just be two. Those first two were so ridiculously excellent because the squirrels were always doing their best to get at the birdseed and it was a daily battle of Seth vs. the squirrels.

Pre-squirrel baffle. Let the battle begin.

We inherited several more when we moved into our new place. It’s not new anymore, but I continue to fill the feeders and we’ve got a lovely crop of birds that come by, particularly in the summer, for a bite. My favorites are the mourning doves that lumber around under the feeders waiting for the little guys to knock seed down for them to eat. But they’re all lovely and chirpy.

Except not everyone agrees. When we had some people over this winter, I was admonished for using the cheapie seed blend — the one that’s always on sale at Fleet Farm. Apparently, it attracts garbage birds.

Those first two stories are old stories. They’re things I think about relatively frequently though. Things that really rubbed me the wrong way. I knows it’s people and birds and not really the same thing, but in both cases, the situation, the prevailing attitude, just seemed unfair.

Why does it matter who ate the food???

And then I went to a really great Grand Rounds presentation the other day by Dr. Michael Harris from OHSU about his Novel Interventions in Children’s Healthcare, or NICH, program… and it tied it all together. The program was incredible, the talk was inspiring, I loved it, but that’s not what brought the point home for me in this context.

Rather, it was a relatively small, illustrative point that Dr. Harris used to describe how people, well, rats, actually, rise to the occassion based on the way they are treated. The way they are handled. The assumptions we make about exactly how far they can rise.

The premise was this: once upon a time, a researcher labeled a bunch of cages of rats either “maze poor” or “maze adept” … something along those lines, anyway. Then he had a research assistant run the rats through a maze and record their results. As expected, the “maze poor” rats did poorly and the “maze adept” rats did well. Except, and here’s the kicker, all the rats were standard lab rats. None were actually maze poor or adept, there was no difference between the two groups except in the way they were handled by the research assistant conducting the test.

Ba-bam.

Dr. Harris went on to explain basically that this is exactly the same thing that he sees happening in clinical care when you’re dealing with children that are both socioeconomically vulnerable and medically fragile. The way their parents get treated– either as deadbeat layabouts who neglect their children vs. parents who are trying to do the best they can with what they have — makes all the difference in health outcomes. Thousands and thousands and thousands of dollars of difference in healthcare costs, too. And that gets big attention.

Completely fascinating. It really made me think. Two things:

1) Maybe I should pick up and move to Oregon to work in the NICH program where my motto will become “Nothing I Can’t Handle” so that I can help kids and their parents when nobody else will.

But more realistically…

2) How often do I treat people like dumb rats?!

{Source} I know, they’re laboratory mice, whose genes have been spliced… not rats.

—-

Ideally, we’d treat everyone like a smart rat. Like they are capable. Maze adept. Good enough to be good at anything you put in front of them. So, what about me? In my daily life, do I treat everyone like a smart rat?

Of course I do. I’m perfect.

…

Actually… sorry, I was thinking of somebody else.

Me?

Heck no!

I’m full up-to-here with prejudices and preconceived notions just like everybody else.

So I’ve got to try to be better. To live life a bit more blinded. Because maybe we’re all just basic, run of the mill rats, doing our own little rat things.

Not dumb rats. Just rats.

Not garbage birds. Just birds.

Not housekeeping people. Just people.

That’s all.

And the rat, the bird, the person… they’ll all respond appropriately to the treatment they’re given.

Birdseed for the “garbage birds” certainly results in gorgeous coos from the mourning doves outside our kitchen window. I see no problem there.

"Rachel V. Stankowski considered herself, among other things, a writer. Primarily due to the positive stigmas that accompanied the label, but also because it seemed to excuse some of her more major eccentricities, vanity included."
My brother, also a writer, wrote that about a fictional character. It might have been about me. So I stole it. He's good; maybe I can be too.